Provider Demographics
NPI:1477516532
Name:SPECIALTY SURGICARE OF LAS VEGAS, LP
Entity Type:Organization
Organization Name:SPECIALTY SURGICARE OF LAS VEGAS, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:7250 CATHEDRAL ROCK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0433
Mailing Address - Country:US
Mailing Address - Phone:702-933-3999
Mailing Address - Fax:702-933-3997
Practice Address - Street 1:7250 CATHEDRAL ROCK DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0433
Practice Address - Country:US
Practice Address - Phone:702-933-3999
Practice Address - Fax:702-933-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3351ASC8261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101698Medicare PIN